Fluid and Electrolyte Balance

Question 1

Infant total body fluid

Answer 1

70-80%

More prone to dehydration due to 50% being ECF

Question 2

3 y/o total body fluid

Answer 2

65%

Question 3

15 y/o total body fluid

Answer 3

60%

Question 4

Maintenance fluid calculation

Answer 4

4ml/kg/hr for first 10kg
2ml/kg/hr for second 10kg
1ml/kg/hr for remainder

Question 5

Respiratory acidosis

Answer 5

Caused by diminished or inadequate pulmonary ventilation –> elevated pCO2 levels, decreased plasma pH

Question 6

Causes of depressed respiratory system

Answer 6

Head injury, narcotic drugs, cystic fibrosis, OPD, pneumonia, atelectasis, factors that affect chest wall

Question 7

Metabolic acidosis

Answer 7

Caused by gain of nonvolatile acids or the loss of base –> decreased plasma bicarbonate (HCO3-) and plasma pH

Question 8

Causes of metabolic acidosis (acid gain or base loss)

Answer 8

Acid gain - indigestion, starvation, infection, aspirin ingestion (acetylsalicylic acid)
Bicarb loss - diarrhea

Question 9

Respiratory alkalosis

Answer 9

Caused by an increase in rate and depth of pulmonary ventilation –> decreased pCO2 levels, elevated plasma pH

Question 10

Causes of increased pulmonary ventilation (rate and depth)

Answer 10

Emotions, mechanical ventilation

Question 11

Metabolic alkalosis

Answer 11

Caused by gain of base or loss of acid –> elevated plasma HCO3- and plasma pH

Question 12

Causes of acid loss

Answer 12

Vomiting, diuretic therapy

Question 13

Isotonic dehydration

Answer 13

Fluid loss involving extracellular fluid and circulating blood volume
Sodium may decrease, chloride decrease, potassium stable

Question 14

Hypotonic dehydration

Answer 14

Water shifts from extracellular fluid to intracellular fluid in an attempt to establish osmotic equilibrium
Sodium and chloride decrease, potassium varies

Question 15

Hypertonic dehydration

Answer 15

Water shifts from intracellular fluid to extracellular fluid
Sodium and chloride increase, potassium varies
Can lead to neurologic disturbances

Question 16

Mild dehydration

Answer 16

Loss of 5% of pre-illness weight

Alert, pale, dry, decreased UOP, decreased skin turgor, VS normal

Question 17

Moderate dehydration

Answer 17

loss of 6-9% of pre-illness weight

Irritable, grey, poor skin turgor, very dry, oliguria, increased HR

Question 18

Severe dehydration

Answer 18

Loss of 10% of pre-illness weight
Lethargic, mottled, very poor skin turgor, parched, marked oliguria, increased HR, rapid/thready pulse, low BP, delayed cap refill

Question 19

Best sign of hydration status

Answer 19

Daily weight

Question 20

Urine specific gravity in dehydration

Answer 20

> 1.030 (high), concentrated

Question 21

Initial replacement for dehydration

Answer 21

Isotonic solution at rate of 10-20 ml/kg
Contraindicated in hypertonic dehydration due to water toxicity
Sodium bicarbonate may be added to correct acidosis
Potassium not added until kidney function is ensured (child voiding)

Question 22

Causes of acute gastroenteritis

Answer 22

Rotavirus - most common cause

Bacterial - E. coli, salmonella, shigella, C. diff

Question 23

Oral rehydration therapy

Answer 23

Start early when child starts having diarrhea

90 mEq/L of sodium - Pedialyte

Question 24

Systemic damage caused by burns (4)

Answer 24

Respiratory compromise due to inhalation injury
Hypovolemic shock
Accelerated metabolic rate - increased body temp, increased nutritional needs
Local infection, sepsis

Question 25

Inhalation injury can cause swelling for ____

Answer 25

2-5 days

Question 26

Hypovolemic shock can occur when total body surface area covers ____

Answer 26

15-20% of body

Question 27

Hypovolemic shock signs

Answer 27

Hypotension, increased HR, weak/thready pulse, prolonged cap refill, cool extremities

Question 28

First sign of sepsis

Answer 28

Disorientation

Question 29

Electrolyte imbalances caused by burns

Answer 29

Elevated fasting blood glucose
Hyponatremia
Hyperkalemia due to cell lysis
Metabolic acidosis due to hypovolemia and cell damage